Evaluations in mental health services: some methodological considerations

Mutual biases underlying the problematic relationship between older adults and mental health providers: any solution in sight?

As the size and diversity of the older population increases, mental health providers will be called upon to deliver high-quality services to the elderly. However, many of these professionals hold negative attitudes toward the elderly; psychotherapy conducted with older adults by clinicians with such biases could represent a waste of time and energy, as well as money, for these clients. This article reviews studies conducted within the past three decades on the biases held by mental health professionals (primarily psychiatrists and psychologists) toward older patients and vice versa. It also discusses possible solutions to the conflicts within the elderly-mental health provider relationship, based on the contributions made by professionals from various health care disciplines on this topic. Moreover, this article takes into account various ethnicity-related issues that are often at play in the relationship in question, and provides research and clinical recommendations for the enhancement of the quality of this relationship. It is time to find successful and interdisciplinary ways to improve how older adults and mental health professionals deal with one another. These efforts should creatively enhance the quality of the mental health services offered to older patients, in addition to dispelling age-related myths and corresponding obstacles to the utilization of these needed services by older adults.

Measuring outcomes in the treatment of alcohol dependency

The selective promotion of clinical services which have proven effectiveness is a movement that is gaining momentum within healthcare. Outcome evaluation in treatment services for alcohol dependency is given as an example of the methodological issues associated with the establishment of clinical efficacy. It is argued that the adoption of clear protocols for assessment, treatment and outcome are a prerequisite of the process. There are costs associated with in-house follow-up studies but the benefits of feedback are evident for patients and for staff providing their care. Although exposing service providers (and commissioners) to the possibility of negative feedback, outcome evaluation in the treatment of alcohol dependency should be an integral part of provision. The principle of systematic assessment of efficacy applies to healthcare provision generally and should include management, teaching, purchasing and policymaking.

Studying the future: a Delphi survey of how multi-disciplinary clinical staff view the likely development of two community mental health centres over the course of the next two years

Two community mental health centres (CMHCs) in North Staffordshire, England were the sites for a recent Delphi survey of multi-disciplinary clinical staff. The views of staff were sought on the likely developments over the next 2 years, at the CMHC where they worked. Each group of staff independently produced healthy numbers of suggestions, with few contradictions; and displayed predominantly positive attitudes, both towards particular suggestions and the future in general. Summarized results were classified within seven themes, producing similar distribution patterns for both CMHCs. The most frequently occurring themes were changing staff roles and CMHC functions and developments in therapies and skills. Mid-placed themes concerned community development and communication/continuity. The least frequently reported themes covered general management, user involvement and quality assurance. Issues raised by the study are discussed and related to other published works, followed by consideration of how the findings might be utilized. Clinical staff have generated a large number of suggestions and, importantly, via rounds of confidential voting, indicated the group consensus on each item. Consequently, management of change should stand a high chance of success. Finally, one means of taking the findings forward is described.